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Title

First Name*

Last Name*

Fax

Phone*

Province*

Postal Code* Ex: L5N 8L2

City*

Company/Organization

Organization/Company*

Institute/Division

Dept

PI

Floor

Building

Room

Street/POBox*

Position

Position*

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Password

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Password again

2.

Type of Request*

3.

Are you reporting Patient Results?*

Yes

No

4.

Your inquiry

Reference Number

Enter case-releated reference number if applicable.

English support possible?

Yes

No

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Instrument Serial Number

For most efficient service on instrument queries, please enter instrument SN if it is available.

Catalog Number

For most efficient service on kit troubleshooting queries, please enter kit catalog number if it is available.

Lot number

For most efficient service on kit troubleshooting queries, please enter kit lot number if it is available.

Files

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